Provider Demographics
NPI:1891274882
Name:WOW FACTOR WINNING OPTIONS IN WELLNESS
Entity Type:Organization
Organization Name:WOW FACTOR WINNING OPTIONS IN WELLNESS
Other - Org Name:WOW FACTOR HEALTH AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:REGISTERED NURSE ADVANCE PRACTICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANNA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:219-381-7371
Mailing Address - Street 1:8660 BROADWAY STE B
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7034
Mailing Address - Country:US
Mailing Address - Phone:219-381-7371
Mailing Address - Fax:
Practice Address - Street 1:301 HAMLIN ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46406-1338
Practice Address - Country:US
Practice Address - Phone:219-381-7371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003896A3104A0625X, 3104A0630X, 311ZA0620X, 363LF0000X
363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1891274882OtherNONE